Mallion J M, Baguet J P, Siché J P, Benkritly A
Service médecine interne et cardiologie, CHU Grenoble.
Arch Mal Coeur Vaiss. 1998 Aug;91(8):1049-53.
The HOT study is the largest controlled therapeutic trial conducted to date in hypertension. This international, prospective, randomised trial is designed to determine the optimal blood pressure to be obtained during treatment, in order to achieve optimal reduction of complications and cardiovascular mortality. The HOT study is conducted according to the PROBE methodology (Prospective Randomised Open Blinded Endpoints. It has three objectives: 1) to evaluate the relationship between the development of major cardiovascular events and the DBP target level (DBP < or = 90, DBP < or = 85 or DBP < or = 80 mmHg. 2) to evaluate the relationship between the development of major cardiovascular events and real DBP observed, 3) to determine whether low-dose acetylsalicylic acid (75 mg/day) provides an additional benefit in terms of cardiovascular morbidity and mortality in treated hypertensive subjects. Between April 1992 and October 1994, 18,790 patients, between the ages of 50 and 80 years (26 countries), were randomised to these 3 target DBP groups and several parameters likely to influence the blood pressure fall were identified. The reduction of DBP was all the more pronounced the higher the baseline DBP. For a baseline DBP equal to 100 mmHg, the mean fall was 18 mmHg and for a baseline DBP equal to 110 mmHg, the mean fall was 27 mmHg. Advanced age was also found to be a factor promoting reduction of DBP, which increased after the age of 65 years. Analysed in relation to the type of treatment, this more marked reduction in the elderly showed that monotherapy with a calcium channel blocker was very effective on DBP and especially after the age of 75 years. The data of the study also showed that SBP decreased in parallel to DBP, but to an even greater extent. Thus, a 10 mmHg reduction of DBP induces a reduction of SBP by approximately 20 mmHg. This reduction of SBP related to the level of DBP was even more marked the higher the baseline SBP and the higher the target DBP objective. Thus 80% of patients in the DBP < or = 80 mmHg group had an SBP < or = 150 mmHg during treatment. Among the other factors, weight appeared to clearly influence reduction of DBP, as the reduction of DBP was more marked the lower the patient's weight. In contrast, the body mass index was poorly correlated with the reduction in blood pressure. The blood pressure reduction, regardless of weight, was more marked when a stricter blood pressure objective was adopted (DBP < or = 80 mmHg). Finally, in the particular case of elderly subjects, treatment with a calcium channel blocker appeared to be very effective in reducing the blood pressure.
高血压优化治疗（HOT）研究是迄今为止开展的规模最大的高血压对照治疗试验。这项国际性、前瞻性、随机试验旨在确定治疗期间应达到的最佳血压水平，以实现并发症和心血管死亡率的最佳降低。HOT研究是按照PROBE方法（前瞻性随机开放盲终点法）进行的。它有三个目标：1）评估主要心血管事件的发生与舒张压目标水平（舒张压≤90、≤85或≤80 mmHg）之间的关系。2）评估主要心血管事件的发生与实际观察到的舒张压之间的关系。3）确定小剂量阿司匹林（75毫克/天）在接受治疗的高血压患者的心血管发病率和死亡率方面是否能带来额外益处。在1992年4月至1994年10月期间，18790名年龄在50至80岁之间的患者（来自26个国家）被随机分配到这3个舒张压目标组，并确定了几个可能影响血压下降的参数。基线舒张压越高，舒张压的下降就越明显。对于基线舒张压等于100 mmHg的情况，平均下降幅度为18 mmHg；对于基线舒张压等于110 mmHg的情况，平均下降幅度为27 mmHg。高龄也被发现是促进舒张压降低的一个因素，65岁以后这种情况更为明显。从治疗类型方面进行分析，老年人中这种更显著的下降表明，使用钙通道阻滞剂进行单药治疗对舒张压非常有效，尤其是在75岁以后。该研究的数据还表明，收缩压与舒张压平行下降，但下降幅度更大。因此，舒张压降低10 mmHg会使收缩压降低约20 mmHg。与舒张压水平相关的收缩压下降在基线收缩压越高和目标舒张压目标越高时更为明显。因此，在舒张压≤80 mmHg组中，80%的患者在治疗期间收缩压≤150 mmHg。在其他因素中，体重似乎明显影响舒张压的降低，患者体重越低，舒张压的下降就越明显。相比之下，体重指数与血压降低的相关性较差。无论体重如何，当采用更严格的血压目标（舒张压≤80 mmHg）时，血压下降更为明显。最后，在老年患者的特殊情况下，使用钙通道阻滞剂进行治疗在降低血压方面似乎非常有效。
